Antibiotics in PHCs & MCs
OCBA - SYRIA Mission

Analyzing supplies of antibiotics from June to December 2023 against the data extracted from HMIS

2023-05-15

Context

  1. Armed conflict with lots of displacements
  2. Working through partnership of DoH and local NGOs (MSF is NOT the direct implementer of services).
  3. Two projects: IDAL and NAP
  4. Supporting PHCs, MCs, BEmONCs and CEmONCs
  5. Regular monthly medical donations based on the facilities consumption
  6. AMR and Antibiotics over-prescribing are quiet spread in Syria

objectives

  1. Evaluate the antibiotic usage:
    is there Antibiotics over-prescribing in Facilities? where? how much? how often?
  2. Evaluate the rational prescribing behavior:
    are first line of ABs prescribed (Access group) or skipped to second line (Watch group) immediately?
  3. Double check the balance between antipyretic courses and antibiotics courses?

Data resources

  • Monthly donations extracted from Isystock (it is based on the facilities monthly consumption)
  • Export HMIS data for all health facilities (HF) for concerned period.
  • Age:
    • Under 5 years U5.
    • 5 years or more O5.
  • consultation categories:
    • Total consultations.

Parameters

  1. define the Antibiotics list in the mission and its category based on WHO AWaRE categorization (Access, Watch)
  2. define Age categories of those medications:
    • Under 5 years U5 (pediatrics: Suspension, Syrups, dispersible tablets and pediatrics injectables
    • 5 years or more O5: Tablets and injectables for adult

  1. Define the Duration of treatment based on MSF1 (the average duration of treatment of the main indication of the drug)
  2. WHO DDD: Daily defined dose is the assumed average maintenance dose (grams) per day for a drug used for its main indication in adults.
  3. Calculation of number of units of medication per course
    • Under 5 years U5:
      each bottle of suspension or syrup are 1 course.

  • 5 years or more O5:
    DDD * DoT / (dose of medication per unit in grams) Amoxicillin 500 mg =>
    DDD is 1.5 gram => duration of treatment is between 5 to 7 days =>
    7 (duration of treatment)* 1.5 (DDD)/ 0.5 (dose of medicine per unit in grams) = 21 tablets
    Amoxicillin 500mgcourse is 21 tablets.

Access group antibiotics

Code Article DDD U AWaRe Age unit_per_course
DINJAMPI1V- AMPICILLIN, 1g, powder, vial 6.00 g Access 5 years or more 6
DINJAMPI5V- AMPICILLIN, 500mg, powder, vial 2.00 g Access Under 5 years 6
DINJCEFA1V- CEFAZOLIN, 1g, (IV), powder, vial 3.00 g Access 5 years or more 6
DINJCLOX5VV CLOXACILLIN sodium, eq. 500mg base, powder, vial IV 2.00 g Access 5 years or more 6
DINJGENT8A- GENTAMICIN sulfate, eq. 40mg/ml base, 2ml, amp. 0.24 g Access 5 years or more 6
DINJMETN5BF METRONIDAZOLE, 5mg/ml, 100ml, bag/bottle PVC free 1.50 g Access 5 years or more 5
DINJPENB2VS BENZATHINE BENZYLPENICILLIN, 2.4 MIU, powder, vial + solvent 3.60 g Access 5 years or more 4
DORAAMOC22TD AMOXICILLIN 200mg/ CLAVULANIC acid, 28.5mg, disp. tab. 1.50 g Access Under 5 years 14
DORAAMOC4S5 AMOXICILLIN 400mg / CLAV.ac. 57mg/5ml, powd.oral susp. 70ml 1.50 g Access Under 5 years 1
DORAAMOC56T AMOXICILLIN 500mg / CLAVULANIC acid, 62.5 mg, tab. 1.50 g Access 5 years or more 18
DORAAMOC81T AMOXICILLIN 875mg / CLAVULANIC acid 125mg, tab. 1.50 g Access 5 years or more 14
DORAAMOX1S1 AMOXICILLIN, 125mg/5ml, powder oral susp., 100ml, bot. 1.50 g Access Under 5 years 1
DORAAMOX2TDB AMOXICILLIN, 250mg, dispersible and breakable tab. 1.50 g Access Under 5 years 21
DORAAMOX5T- AMOXICILLIN, 500mg, tab. 1.50 g Access 5 years or more 21
DORACEFX2C- CEFALEXIN, 250mg, caps. 2.00 g Access 5 years or more 56
DORACLOX2C- CLOXACILLIN sodium, eq. 250mg base, caps. 2.00 g Access 5 years or more 56
DORACLOX5C- CLOXACILLIN sodium, eq. 500 mg base, caps. 2.00 g Access 5 years or more 28
DORADOXY1T- DOXYCYCLINE salt, eq. 100mg base, tab. 0.10 g Access 5 years or more 10
DORAMETN2S- METRONIDAZOLE benzoate,eq.200mg/5ml base,oral susp,100-120ml 2.00 g Access Under 5 years 1
DORAMETN2T- METRONIDAZOLE, 250mg, tab. 2.00 g Access 5 years or more 20
DORAMETN5T- METRONIDAZOLE, 500mg, tab. 2.00 g Access 5 years or more 20
DORANITR1T- NITROFURANTOIN, 100mg, tab. 0.20 g Access 5 years or more 14
DORATINI5T- TINIDAZOLE, 500mg, tab. 2.00 g Access 5 years or more 4

Watch group antibiotics

Code Article DDD U AWaRe Age unit_per_course
DINJCEFO5V- CEFOTAXIME sodium, eq. 500mg base, vial 2.0 g Watch Under 5 years 6
DINJCEFT1V- CEFTRIAXONE sodium, eq. 1g base, powder, vial 2.0 g Watch 5 years or more 6
DINJCEFT2V- CEFTRIAXONE sodium, eq. 250mg base, powder, vial 2.0 g Watch Under 5 years 3
DORAAZIT2T- AZITHROMYCIN, 250mg, tab. 0.3 g Watch 5 years or more 6
DORAAZIT3S- AZITHROMYCIN, 200mg/5ml, powder oral susp., 30ml, bot. 0.3 g Watch Under 5 years 1
DORAAZIT5T- AZITHROMYCIN, 500mg, tab 0.3 g Watch 5 years or more 3
DORACEFI2S- CEFIXIME, 100mg/5ml, powder for oral susp., 60 ml, bot. 0.4 g Watch Under 5 years 1
DORACEFI2T- CEFIXIME, 200 mg, tab. 0.4 g Watch 5 years or more 10
DORACIPR2T- CIPROFLOXACIN hydrochloride, eq. 250mg base, tab. 1.0 g Watch 5 years or more 20
DORACIPR5T- CIPROFLOXACIN hydrochloride, eq. 500mg base, tab. 1.0 g Watch 5 years or more 14
DORAERYT5T- ERYTHROMYCIN stearate, eq. 500mg base, tab. 1.0 g Watch 5 years or more 18
DORAFOSF3S- FOSFOMYCIN trometamol, eq. 3g base, sachet 3.0 g Watch 5 years or more 1

Antibiotic Mission view

Mission’s ratio of Access to Watch - 5 years or more

Mission’s Percentage of Antibiotics & Antipyrretics to consultations - 5 years or more

Mission’s ratio of Access to Watch - Under 5 years

Mission’s Percentage of Antibiotics & Antipyrretics to consultations - Under 5 years

  • there is a downtrend in Antibiotic consumption in category 5 Years and more throughout the analysis period. (improvement)

  • the consultation rate is almost stable of category 5 years and more. (improvement)

  • the trend of antibiotic consumption of category under 5 years is stable somehow. (neutral)

  • ratio of Watch group to Access group is still high in under 5. (neutral)

  • rate of Antibiotic consumption in Under 5 years is almost double the 5 years and more. (neutral)

Access vs Watch AB

IDAL Project view

steep drop in consuption of AB in last summer season the stable low consmption of AB, Accepted ratio (Access to Watch)

surge in Watch ratio (Access to Watch) since starting supporting the NICU in Dec

decline in AB consumption (look suspiciously low in last 6 months)

there is downtrend in total without any change in the ratio (Access to Watch)

there is steep decline in AB consumption since the Earthquake in Feb

steep decline in watch group since Feb (investagation is needed)

uptrend in AB consumption with two Surges (Feb and Apr), to improve the ratio (Access to Watch)

uptrend in AB consumption since Jan, the ratio (Access to Watch) needs improvement

ratio (Access to Watch) needs improvements

ratio (Access to Watch) needs improvements, suspicioius surge in Jun

downtrend since Dec, good ratio (Access to Watch) also

stable AB consumption and good ratio (Access to watch)

downtrend and improvement in AB consumption and ratio (Access to Watch)

decline in AB since Apr with good ratio (Access to Watch) overall

NAP Project view

ratio of (Access to Watch) close to each others, two surges one in Feb EQ and the other last summer

stable AB consumption with surge in Feb EQ, the ratio (Access to Watch) needs improvement

Inverted ratio (Access to Watch), Investigate

ratio (Access to Watch) needs improvements, Investage Oct surge

Inverted Ratio (Access to Watch), Investage

uptrend in watch (CLOSED)

acceptable ratio (Access to Watch) (CLOSED)

high fluctuations in AB and the ratio (Access to Watch)

fluctuation in AB and ratio (Access to Watch)

increase in watch in last three months (almost inverted ratio)

acceptable ratio (Access to Watch)

acceptable ratio (Access to Watch)

acceptable ratio (Access to Watch)

high ratio of Watch (equal)

good ratio (Access to Watch)

Percentage of AB prescription to consultation

IDAL project view

very good cooporation and response

since Jan they stoped collecting paed data only from NICU

very good ratios

good ratio

decline in AB ratio since Feb, WHY?

high consumption of AB in winter months and less, invistgate April surge in antipyrrtic

this PHC is growing in all terms (consultations and consumption)

very high consumption since March (almost evey chil is given AB and antipyretic

new facility, good ratio

new facility, Investigate June data

there is noticeable imporvement and still there window for more improvement

NO noticicable improvement (need strict actions)

AB consumption is improving

good improvement and ther is still a window for more

NAP Project view

good ratio

good ratio

good ratio

good ratio

unstable nr of consultaion, to check the data?

good ratio, CLOSED

always growing consumption, CLOSED

good ratio

good ratio, investagate Feb surge

good ratio

good ratio, check last months surge in antipyretics

good ratio

acceptable ratio, investigate last 2 months surge

good ratio

very high AB consumption rate

Percentage of AB prescription to infectious cases

IDAL project view

very good cooporation and response

since Jan they stoped collecting paed data only from NICU

very good ratios

good ratio

decline in AB ratio since Feb, WHY?

high consumption of AB in winter months and less, invistgate April surge in antipyrrtic

this PHC is growing in all terms (consultations and consumption)

very high consumption since March (almost evey chil is given AB and antipyretic

new facility, good ratio

new facility, Investigate June data

there is noticeable imporvement and still there window for more improvement

NO noticicable improvement (need strict actions)

AB consumption is improving

good improvement and ther is still a window for more

NAP Project view

good ratio

good ratio

good ratio

good ratio

unstable nr of consultaion, to check the data?

good ratio, CLOSED

always growing consumption, CLOSED

good ratio

good ratio, investagate Feb surge

good ratio

good ratio, check last months surge in antipyretics

good ratio

acceptable ratio, investigate last 2 months surge

good ratio

very high AB consumption rate

Observation & Recommendations

Observations:

Recommendations: